591795 p 11/13 QUICK gUIde to CIgna Id Cards

2013
QUICK guide to
Cigna ID cards
591795 p 11/13

We pack a lot of
important information
into our ID cards.
This brochure can help define and clarify information
that appears on Cigna’s most common customer ID
cards. It can also help you understand the requirements
associated with our various plans, allowing you to
quickly and efficiently serve your patients.
We may occasionally update this brochure during the
year. Download the most current version at Cigna.com >
Health Care Professionals > Resources for Health Care
Professionals > Doing Business with Cigna.
please note:
There are various standard Cigna ID cards shown in this
brochure that are subject to regulatory oversight. As a
result, the actual ID card content may vary in order to
conform to legislative and regulatory requirements.
The ID cards shown are samples and may vary from the
actual cards.

Key
Refer to this key for explanations of the information
found on the sample Cigna ID cards featured in
this brochure.
1 Use this ID number for all claims and inquiries.
2 Indicates a seamless network where a patient can
receive in-network care on a regional or statewide basis.
3 For patients with coinsurance, submit claims to Cigna
or its designee, and receive an Explanation of Payment
(EOP), which will show any remaining amount due
from patient.
4 Collect any copayment at the time of service.
5 May read as “Connecticut General Life Insurance Co.,”
“Cigna Health and Life Insurance Company” or “Cigna
HealthCare of XXXX, Inc.”
6 ID cards with the Cigna Care Network® logo indicate
the patient’s liability varies based on the health care
professional’s Cigna Care designation status. Refer
to the online health care professional directory to
determine a physician’s Cigna Care designation status.
7 Effective date of coverage.
8 Name of patient‘s primary care physician (PCP).
9 Network Savings Program (NSP) logo indicates
that out-of-network discounts may be available to
the customer.
10 Client name.
11 If a third party administers services in conjunction with
Cigna, the ID card may include multiple logos and may
show a different claim address or telephone number on
the back of the card.
12 Precertification requirements may be shown as either
“Inpatient Admission” or “Inpatient Admission and
Outpatient Procedures.’’
13 Submit claims to the claim submission address shown
on the card.
14 Call the Customer Service number(s) indicated on
the card. Some plans have dedicated numbers for
accessing information – be sure to check the card for
the correct number.
15 “Away From Home Care” indicates the patient has
access to the Cigna national network.
16 Indicates Shared Administration.
17 Union identifier.
18 Client-specific network (CSN) logo.

RUN_DATE DATA_SEQ_NO CLIENT_NUMBER UHG_TYPE DOC_ID DOC_SEQ_ID NAME MAILSET_NUMBER CUST_KEY1 CUST_KEY2 CUST_KEY3 CUST_KEY4 CUST_KEY5
CUST_KEY6 Doe 9116687/000001-00
9116687/000001-01
9116687/000001-02
20130314 DIG1CARD 00699998 100000008
John Doe 0000001
003040 0000001 05:58:28 ,John
RUN_DATE DATA_SEQ_NO CLIENT_NUMBER UHG_TYPE DOC_ID DOC_SEQ_ID NAME MAILSET_NUMBER CUST_KEY1 CUST_KEY2 CUST_KEY3 CUST_KEY4 CUST_KEY5
CUST_KEY6 Doe 9116687/000001-00
9116687/000001-01
9116687/000001-02
20130314 DIG1CARD 00699998 100000008
John Doe 0000001
003040 0000001 05:58:28 ,John
Primary Care $30 Specialist $40
Urgent Care $65 Preventive Care $20
PCP: None Selected
No Referral Required
For plan & benefit details, please visit myCIGNAforhealth.com
Plan Contractor: Connecticut General Life Insurance Company
Members and Providers Call
1-866-494-2111
GWH-Cigna Plans
03040 9116687 0000 0000001 0000001 072 7117
03040 9116687 0000 0000001 0000001 072 7117
XYZ Company
RXBIN 600428 10
RXPCN 05180000
Issuer 80840
Group Plan 123456789
John Public
ID 123456789 01 1
COPAY:
Primary Care $30 4 Specialist $40
Urgent Care $65 ER $200
PCP: None Selected
No Referral Required
8
>000001 9116687 001 003040
>000001 9116687 001 003040
For plan & benefit details, please visit myCIGNAforhealth.com
• PCP selection encouraged
• No referrals required
• GWH-Cigna ID cards represent all products
Cigna Health Cigna and Health Life Insurance and LifeCompany
Insurance Company
GWH-Cigna
GWH-CIGNA Plan Type
Open
Plan
Access
Type
Plus
Submit All Claims To
1000 Great-West Drive
Kennett, MO 63857-3749
Payer ID #62308
Members and Providers Call
1-866-494-2111
Group 00699998 Group 00699998
Issuer (80840) Issuer (80840)
ID 100000008 ID 100000008 1
Copays Copays 4
Name JohnName Doe John Doe
Primary Care Primary $25 Care $25
PCP NonePCP Selected None Selected
Specialist $25
No Referral Required 8
Specialist $25
No Referral Required
Urgent Care $100 Urgent Care $100
ER $200
XYZ Sample
XYZ
CompanyHoldings
Sample CompanyHoldings
Co.
ER $200
Co.
11
10
RxBIN 600428 RxPCN 05180000
RxGrp 00688888
RxBIN 600428 RxPCN 05180000
RxGrp 00688888
RxID 100000008
RxID 100000008
00
00
5
13 12
14
9
12
13
14
9
Members: Carry this card at all times. Pretreatment authorization must be obtained for hospital
admissions, outpatient surgeries performed outside a physician’s office and for the other services
specified in the benefit plan. Member is responsible for obtaining authorization for non-network
services. Failure to follow pretreatment authorization procedures may result in a reduction of
benefits. In an emergency, seek care immediately, then call your primary care doctor as soon as
possible for further assistance. We encourage you to use a primary care physician as a valuable
resource and personal health advocate.
CIGNA has multiple networks. Your plan is paired with the GWH-CIGNA network. To find a
GWH-CIGNA provider, please visit your member website at myCIGNAforhealth.com.
Providers: Pretreatment authorization must be received for all services listed above and as
specified in the member’s benefit plan by calling the number on the front of this card or online
at CignaforHCP. com. Emergency hospital admissions must be reported within 48 hours.
Notice: Possession of this card does not guarantee coverage or payment for the service or
procedure reviewed. Please call the Member and Providers number on the front of this card for
eligibility information.
For providers not in your primary
network, visit multiplan.com
For Pharmacists Only 1-800-XXX-XXXX
What doesit mean?
What doesit mean?
R318 (5/10) Mask 401
Your share of the payment for health care services may be based
upon our agreement withyour provider. Your provider may billyou
for amounts up to the provider's regular billed charges.
*117* *117*
'Cigna' is aregistered service mark, and the 'Tree of Life' isaservice
mark, of Cigna Intellectual Property, Inc., licensed for use by Cigna
Corporation and its operating subsidiaries. All products and services are
provided by or throughsuch operating subsidiaries and not by Cigna
Your share of the payment for health care services may be based
Corporation. Such operating subsidiaries include Connecticut General
upon our agreement withyour provider. Your provider may billyou
Life Insurance Company, Cigna Health and Life Insurance Company, Cigna
for amounts up to the provider's regular billed charges.
Health Management, Inc. and Cigna Dental Health, Inc. The Cigna Dental
PPO is underwritten or administered by Connecticut General LIfe Insurance
Issue Date: 01/01/12
Company 'Cigna' is aregistered orCigna Health service and mark, Life Insurance and the 'Tree Company of Life' with isaservice network
management mark, of Cigna services Intellectual provided Property, by Cigna Inc., Dental licensed Health, for use Inc., by and Cigna certain
of Corporation its operating and subsidiaries. its operating subsidiaries. All products and services are
provided by or throughsuch operating subsidiaries and not by Cigna
Corporation. Such operating subsidiaries include Connecticut General
Life Insurance Company, Cigna Health and Life Insurance Company, Cigna
Health Management, Inc. and Cigna Dental Health, Inc. The Cigna Dental
PPO is underwritten or administered by Connecticut General LIfe Insurance
Company orCigna Health and Life Insurance Company with network
management services provided by Cigna Dental Health, Inc., and certain
of its operating subsidiaries.
Send All Claims To
Send
1000
All
Great-West
Claims To
Drive
1000
Kennett,
Great-West
MO63857-3749
Drive Kennett,
Payer
MO63857-3749
ID #62308
Payer ID #62308
Customers &Health Care Professionals call 1-866-494-2111
Rx Claims: Pharmacy Customers Service Center, &Health PO Box 3598, Care Scranton Professionals PA 18505-0598call 1-866-494-2111
Rx Claims:
For
Pharmacy
Pharmacists
Service
Only
Center,
800-351-9170
PO Box 3598, Scranton PA 18505-0598
For Pharmacists Only 800-351-9170
Mask 601 Issue Date: 03/14/13
Mask 601 Issue Date: 03/14/13
Global Health Benefits
• PCP selection encouraged
• No referrals required
• GWH-Cigna ID cards represent all products
00000000
00000000
DIRECT
USPS
DIRECT
USPS
John Doe
888 N Main JohnSt
Doe
Olympia, 888 WA N98502
Main St
Olympia, WA 98502
10
1
20130313
20130313
Thu Mar 14, 2013 @ 05:58:28
N
Thu Mar 14, 2013 @ 05:58:28
601
N
601
• PCP selection encouraged
• Patients in these Cigna-administered plans use Cigna PPO or Cigna OAP networks in the U.S., as indicated on the back of the card
• Network Savings Program logo on back of card indicates out-of-network discounts may apply
12
14
13
9
15
1

Shared Administration (SAR) Cigna Choice Fund ® OA Plans
Shared Administration PPO
Shared Administration OAP
TPV logo
Legal entity name
Coverage effective date: MM/DD/CCYY 7 Choice Fund Open Access Plus
Group: 1234567
No referral required
Issuer (80840)
PCP Visit 15%/20%
Specialist
3
15%/20%
ID: U23456789 01
1
Hospital ER 20%
Name: John Public
Vision
Yes
PCP: John Smith
Rx 30%/40%/50%
PCP Name Ln2
8
Network Coinsurance:
In 90%/10%
PCP Phone: XXX.XXX.XXXX
Out 70%/30%
ID card acct name 10
NSP
Med/Rx deductible applies
RxBIN 600428 RxPCN 02150000 logo 9
DOI
Network Savings Program
850702
• PCP selection encouraged
• Cigna Choice Fund® and medical plan type indicated
• Most coinsurance information shown
• Coinsurance/deductible is paid directly to the doctor/facility by Cigna using
patient’s available health funds. Explanation of Payment (EOP) will show any
remaining amount due from patient
TPV logo
• Cigna Care Network is available
CSN logo
Cigna
Care Network
Legal entity name
Coverage effective date: MM/DD/CCYY
Group: 1234567
Issuer (80840)
ID: U23456789 01 1
Name: John Public
S 16
This plan is self-funded by:
ID card account name
Fund #: SAR F
RxBIN Rx Bin RxPCN 02150000
DOI
TPV logo
11
11
Legal entity name
Coverage effective date: MM/DD/CCYY
Group: 1234567
Issuer (80840)
ID: U23456789 01 1
Name: John Public
S 16
PCP: James Smith
PCP name Ln2
PCP phone: 860-555-1212
Fund Name
Fund #: Fund number
RxBIN 600428 RxPCN 02150000
DOI
• PCP selection encouraged
• No referrals required
• Cigna Care Network is available
5
5
11
5
7
7
18
6
Client
logo
Provider network:
Cigna HealthCare PPO
Doctor visit $10 4
Specialist $20
Coinsurance 3
In-network 90% / 10%
Out-of-network 70% / 30%
Rx 30% / 40% / 50%
Deductible applies
Client
logo
Client
logo
Open Access Plus
No referral required
4
Cat#
PCP visit $15
Specialist $20
Rx 30% / 40% / 50%
Network coinsurance:
3
In 90% / 10%
Out 70% / 30%
Deductible applies
Cat#
12
13
WWW.CIGNA.COM
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION:
Your provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your
pre-certification requirements. Failure to do so may affect benefits. In an emergency, seek care immediately, then call your primary
care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.
Coinsurance/deductible is paid directly to the doctor/facility by Cigna using individual’s available health funds.
For Pharmacy, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
For Vision, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
Send claims to:
CAD Name, PO Box XXXX, Anytown, USA 12345-6789
TPV Name, PO Box XXXX, Anytown, USA 12345-6789
All Others: PO Box XXXX, Anytown, USA 12345-6789
Customer Service: 1.800.XXX.XXXX 14 16
MH/SA: 1.800.XXX.XXXX
We encourage you to use a PCP as a valuable resource and personal health advocate.
AWAY FROM HOME CARE
• Coinsurance/deductible should not be collected at the time of service unless
you have accessed the Cigna Cost of Care Estimator®on the Cigna for Heath Care
Professionals website (Cignaforhcp.com) to obtain an estimate of the patient’s
costs, and provide a copy of the estimate to the patient
• Collecting at the time of service without accessing the Cigna Cost of Care Estimator
may result in overpayment and require a refund to the patient
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
12 INPATIENT ADMISSION:
Your provider must call the toll-free number listed below to pre-certify your medical services or benefits may be affected. Refer to your
plan documents for your plan’s precertification requirements. In an emergency, seek care immediately, then notify Cigna within 48 hours.
Mail all non-medical claims and correspondence to: ID card name back
SAR fund name
13 Submit/mail claims to: Cigna Payor 62308, PO Box 188004, Chattanooga, TN 37422-8004
All other:
TPV N&A print line
Pre-certification: Member Srvc Nu Pharmacy Questions: 1.800.244.6224
Eligibility, Benefit and Claim questions please call: SAR TPA phone 14
To access the online provider directory go to www.CignaSharedAdministration.com
To access member pharmacy tools go to www.myCigna.com
15 AWAY FROM HOME CARE
Benefits are not insured by Cigna HealthCare 17
12
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION:
Your network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents
for your pre-certification requirements. Failure to do so may affect benefits. In an emergency, seek care immediately, then call your
primary care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.
Mail all non-medical claims and correspondence to:
Fund name
Fund address
Send claims to: Claims address 13
All others: PO Box XXXX, Anytown, USA 12345-6789
Pre-certification: Member Srvc Nu
Pharmacy Questions: Pharm Num
Eligibility, Benefit and Claim Questions: Please call Payor Num 14
To access the online provider directory go to www.cignasharedadministration.com
To access member pharmacy tools go to www.mycigna.com
We encourage you to use a PCP as a valuable resource and personal health advocate.
AWAY FROM HOME CARE
15 17
2

Managed Care Plans: Open Access
Open Access Plus Network Open Access
TPV logo
Legal entity name
Coverage effective date: MM/DD/CCYY
Group: 1234567
Issuer (80840)
ID: U23456789 01
Name: John Public
PCP: James Smith
PCP Name Ln2
PCP Phone: XXX.XXX.XXXX
• PCP selection encouraged
• No referrals required
• In-network coverage only, except emergency care
TPV logo
CSN logo
Cigna
Care Network
18
6
55
7
Legal entity name
Coverage effective date: MM/DD/CCYY 7
Group: 1234567
Issuer (80840)
ID: U23456789 01 1
Name: John Public
PCP: James Smith
8
PCP Name Ln2
PCP phone: XXX.XXX.XXXX
ID card acct name 10
NSP
RxBIN 600428 RxPCN 02150000 logo 9
DOI
Network Savings Program
Client
logo
Network Open Access
No referral required
PCP Visit $10/$25
Specialist $10/$25
Hospital ER 4 $50
Urgent Care $25
Vision
Yes
Rx $10/20%/40%/100%
Rx Indiv Deduct $50
ID card acct name
NSP
RxBIN 600428 RxPCN 02150000
Coinsurance applies
logo 9
DOI
Network Savings Program
11
11
1
8
10
5
CSN logo
Cigna
Care Network
18
6
Client
logo
Open Access Plus
No referral required
PCP visit $10/$25
Specialist $10/$25
Hospital ER $50
Urgent care $25
Vision
Yes
Rx $10/20/30
Network Coinsurance:
In 90%/10%
Out 70%/30%
Med/Rx deductible applies
• PCP selection encouraged
• No referrals required
• Open Access Plus: In-network and out-of-network coverage
• Open Access Plus In-network: In-network coverage only, except emergency care
3
3
SAR
Cat#
4
WWW.CIGNA.COM
You may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with all
terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION:
Your provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your
pre-certification requirements. Failure to do so may affect benefits. In an emergency, seek care immediately, then call your primary
care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.
For information about mental health services and coverage, call MHSA Stmt Tel
Med Group: Sunset Med Group
Send claims to: 123 Main Street, Suite 999, Anytown, USA 12345-6789 13
For Pharmacy, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
For Vision, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
Cigna Claims: PO Box XXXX, Anytown, USA 12345-6789
TPV Name, PO Box XXXX, Anytown, USA 12345-6789
CSN Name, PO Box XXXX, Anytown, USA 12345-6789
Customer Service: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXX
12
12
14
WWW.CIGNA.COM
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION AND OUTPATIENT PROCEDURES:
Your network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents
for your pre-certification requirements. Failure to do so may affect benefits. In an emergency, seek care immediately, then call your
primary care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.
For pharmacy, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
For vision, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
Send claims to:
CAD name, PO Box XXXX, Anytown, USA 12345-6789
13
TPV name, PO Box XXXX, Anytown, USA 12345-6789
All others: PO Box XXXX, Anytown, USA 12345-6789
Customer service: 1.800.XXX.XXXX 14 MH/SA: 1.800.XXX.XXXX
We encourage you to use a PCP as a valuable resource and personal health advocate.
15
AWAY FROM HOME CARE
HMO or POS Open Access
CSN logo
TPV logo
Cigna
Care Network
5
Legal entity name
Coverage effective date: MM/DD/CCYY
7
Group: 1234567
Issuer (80840)
ID: U23456789 01 1
Name: John Public
PCP: James Smith 8
PCP Name Ln2
PCP Phone: XXX.XXX.XXXX
ID card acct name 10
RxBIN 600428 RxPCN 02150000 NSP
logo 9
DOI
Network Savings Program
Client
logo
POS (or HMO) Open Access
No referral required
PCP Visit $15/$25
Specialist $15/$25
Hospital ER $50
Urgent Care $25
Vision
Yes
Rx $10/20%/40%/100%
Rx Indiv Deduct $50
Coinsurance applies
• PCP selection encouraged
• No referrals required
• HMO Open Access: In-network coverage only, except emergency care
• POS Open Access: Offered as an HMO or Network plan; in-network and out-of-network coverage
2
4
3
SAR
12
WWW.CIGNA.COM
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION:
Your network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents
for your pre-certification requirements. Failure to do so may affect benefits. In an emergency, seek care immediately, then call your
primary care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.
For information about mental health services and coverage, call MHSA Stmt Tel
Med Group: Sunset Med Group 13
Send claims to:
For pharmacy, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
For vision, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
Cigna claims: PO Box XXXX, Anytown, USA 12345-6789
TPV name, PO Box XXXX, Anytown, USA 12345-6789
CSN name, PO Box XXXX, Anytown, USA 12345-6789
Customer service: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXX
14
3

LocalPlus ®
TPV logo
11
Legal entity name
Coverage effective date: MM/DD/CCYY
Group: 1234567
Issuer (80840)
1
ID: U23456789 01
Name: John Public
PCP: James Smith
Jane Smith
PCP Phone: 860.123.4567
ABC12 & Sons Company
RxBIN 600428 RxPCN 02150000
DOI
CSN logo
NSP
logo
9
18
Network Savings Program
Client
logo
LocalPlus
No referral required
PCP Visit $10
Specialist $15 4
Hospital ER $50
Urgent Care $25
Vision
Yes
Rx $10/20/30
Network coinsurance:
In 90%/10%
Out 70%/30%
Med/Rx deductible applies
Cat #
WWW.CIGNA.COM
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION AND OUTPATIENT PRECEDURES: 12
Your provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your
pre-certification requirements. Failure to do so may affect benefits. In an emergency, seek care immediately, then call your primary
care doctor as soon as possible for further assistance and directions on follow-up care within EF hours.
Coinsurance/deductible is paid directly to the doctor/facility by Cigna using individual’s available health funds.
Carve out 1 Prt Line
Carve out 2 Prt Line
13
Send claims to:
CAD Name, PO Box XXXX, Anytown, USA 12345-6789
TPV Name, PO Box XXXX, Anytown, USA 12345-6789
All Other: PO Box XXXX, Anytown, USA 12345-6789
Customer Service: 1.800.XXX.XXXX 14 MH/SA: 1.800.XXX.XXXX
Open Access Plus
15
We encourage you to use a PCP as a valuable resource and personal health advocate.
AWAY FROM HOME CARE
• • PCP No selection referral required encouraged
• • Cigna LocalPlus: Choice In-network Fund® and and medical out-of-network plan type indicated coverage
• • Most LocalPlusIN: coinsurance In-network information coverage shownonly, except emergency care
• Coinsurance/deductible is paid directly to the doctor/facility by Cigna using
patient’s available health funds. Explanation of Payment (EOP) will show any
remaining amount due from patient
• Coinsurance/deductible should not be collected at the time of service unless
you have accessed the Cigna Cost of Care Estimator®on the Cigna for Heath Care
Professionals website (Cignaforhcp.com) to obtain an estimate of the patient’s
costs, and provide a copy of the estimate to the patient
• Collecting at the time of service without accessing the Cigna Cost of Care Estimator
may result in overpayment and require a refund to the patient
Managed Care Plans: Primary Care Physicians
HMO or POS
Network
Legal entity name
Coverage effective date: MM/DD/CCYY
Group: 1234567
Issuer (80840)
ID: U23456789 01 1
Name: John Public
PCP: John Smith 8
PCP phone: XXX-XXX-XXXX
ID card acct name
RxBIN Rx Bin RxPCN Rx Contr
NSP
DOI
logo 9
Network Savings Program
Client
logo
HMO (or POS)
PCP visit $15
Specialist $15
Hospital ER
4
$50
Urgent care $25
Vision
Yes
Rx 41/$20/$40
Rx indiv deduct $50
Coinsurance applies
• PCP selection required
• Referrals required
• HMO: In-network coverage only, except emergency care
• POS: Offered as an HMO or Network plan; in-network and out-of-network coverage
TPV logo
11 bl
10
CSN logo
Cigna
Care Network
5
18
6
Legal entity name
Coverage effective date: MM/DD/CCYY
7
Group: 1234567
Issuer (80840)
ID: U23456789 01
Name: John Public 1
PCP: James Smith
PCP Name Ln2 8
PCP Phone: XXX.XXX.XXXX
ID card acct name 10
RxBIN 600428 RxPCN 02150000 NSP
logo 9
DOI
Network Savings Program
5
7
2
2
Client
logo
Cat#
Network
PCP Visit $15/$20
Specialist 4 $15/$20
Hospital ER $50
Urgent Care $25
Vision
Yes
Rx $10/20%/40%/100%
Rx Indiv Deduct $50
Coinsurance applies
3
3
OAP#
12
bo
14 bo
13
bn
You may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with all
terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION:
Your provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your
pre-certification requirements. Failure to do so may affect benefits. In an emergency, seek care immediately, then call your primary
care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.
For information about mental health services and coverage, call MHSA Stmt Tel
Med Group: Sunset Med Group
Send claims to: 123 Main Street, Suite 999, Anytown, USA 12345-6789 13
For Pharmacy, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
For Vision, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
Cigna Claims: PO Box XXXX, Anytown, USA 12345-6789
TPV Name, PO Box XXXX, Anytown, USA 12345-6789
CSN Name, PO Box XXXX, Anytown, USA 12345-6789
12
Customer Service: 1.800.XXX.XXXX
WWW.CIGNA.COM
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION:
Your network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents
for your pre-certification requirements. Failure to do so may affect benefits. In an emergency, seek care immediately, then call your
primary care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.
Med group: Sunset Med Group
Send claims to: 123 Main Street, Suite 999, Anytown, USA 12345-678
For pharmacy: Call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
For vision: Call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
Cigna: PO Box XXXXX, Anytown, USA 12345-6789
Member services: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXX C
WWW.CIGNA.COM
MH/SA: 1.800.XXX.XXXX
• PCP selection required
• Referrals required
• In-network coverage only, except emergency care
4

2012 Starbridge - CIGNA HealthCare PPO
2012 Starbridge - CIGNA HealthCare PPO
Primary Network: CIGNA Primary HealthCare Network: PPO CIGNA HealthCare PPO
Secondary Network: Beech Secondary TPV Street / Alliance Network: Beech Street
Connecticut TPV / Alliance General Connecticut Life Insurance LogoGeneral Company Life Insurance Company
Logo
www.starbridge.com
Primary Network: CIGNA HealthCare PPODoctor Visit Doctor $25 Visit $25
Coverage Effective Date: Coverage 00/00/0000 Effective Date: 00/00/0000
Secondary Network: Beech Street Specialist 7
www.starbridge.com Specialist $25
$25 4
Primary Network: CIGNA HealthCare PPO
Secondary
ID: AMI Network: Beech ID: Connecticut Street AMIGeneral Life Insurance Company Network Coinsurance: Network Coinsurance:
Connecticut General Life Insurance Company
In
Name:
Doctor
In
Visit
80%/20%
$25
80%/20%
Name: Name Coverage Name Effective Date: 00/00/0000 Out
Doctor Visit Specialist
Out
$25 SM80%/20%
3 SM $25
80%/20%
Coverage Effective Date: 00/00/0000
Account Number: Account ID: 2466518 AMI Number: 2466518 Specialist Network $25 Coinsurance:
ID: AMI
Network Coinsurance: In 80%/20%
Name: Name
Group Name:
In Out 80%/20% SM 80%/20%
Name:
Group Name:
Group Number: Group Out
Account Number: Number: 2466518 SM 80%/20%
Account Number: 2466518
Fundamental Care
TPV / Alliance
Logo
Group Name:
Group Number:
TPV / Alliance
Logo
11
Group Name:
A V I A N T N E T W O
A
R K
V I A N T N E T W O R K
Group Number:
• No PCP selection required
A V I A N T N E T W O R K
• No referrals required
• In-network and out-of-network coverage
2012 FundamentalCare 2012 FundamentalCare - CIGNA - HealthCare CIGNA HealthCare PPO PPO
5
A V I A N T N E T W O R K
www.fundamentalcare.com www.fundamentalcare.com
You may be asked to You present may this be asked card when to present you receive this card care. when The you card receive does not care. guarantee The card does not guarantee
coverage. You must comply coverage. with You all must terms comply and conditions with all terms of the and plan. conditions Willful misuse of the of plan. this Willful card ismisuse of this card is
considered fraud. considered fraud.
This plan does not require This plan pre-certification does not require of coverage pre-certification for inpatient of coverage or outpatient for inpatient services. or Claims outpatient will services. Claims will
be paid according to be terms You paid may and according be conditions asked to to terms of present the and plan. this conditions In card the when case of of the you an plan. receive emergency, In the care. case seek The of card care an emergency, does not guarantee seek care
coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is
You immediately, may be asked then to call present
immediately, your family this card physician then
when
call your
you for further receive
family assistance physician
care. The
for
card and further direction does not
assistance regarding guarantee
and follow direction up care. regarding follow up care.
considered fraud.
coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is
considered Send Claims fraud. to: TPV Send / This Alliance Claims plan does Mailing to: not TPV Address require / Alliance pre-certification 13Mailing Address of coverage for inpatient or outpatient services. Claims will
This All others plan does to: CIGNA not require HealthCare, All be others paid
pre-certification
according to: P.O. CIGNA Box to 188004, HealthCare, of
terms
coverage
and Chattanooga, P.O. conditions
for Box inpatient 188004, TN of 37422 the
or outpatient Chattanooga, plan. In the Payor services.
case TN 62308 of 37422 Claims
an emergency,
willPayor seek 62308 care
be paid according to terms
immediately,
and conditions
then call
of
your
the plan.
family
In
physician
the case of
for
an
further
emergency,
assistance
seek
and
care
direction regarding follow up care.
immediately, Customer then Service: call Customer your family physician 1.800.XXX.XXXX
Service: for further assistance 1.800.XXX.XXXX 14and direction regarding follow up care.
Send Claims to: TPV / Alliance Mailing Address
CIGNA 24-hour CIGNA Nurseline: 24-hour 1.866.XXX.XXXX
Nurseline: 1.866.XXX.XXXX
Send Claims to: TPV / Alliance others Mailing to: CIGNA Address HealthCare, P.O. Box 188004, Chattanooga, TN 37422 Payor 62308
All others to: CIGNA HealthCare, P.O. Box 188004, Chattanooga, TN 37422 Payor 62308
Customer Service: 1.800.XXX.XXXX
Customer Service: CIGNA 1.800.XXX.XXXX
24-hour Nurseline: 1.866.XXX.XXXX
CIGNA 24-hour Nurseline: 1.866.XXX.XXXX
Provider: Participant Provider: is enrolled Participant in a limited-benefit is enrolled plan. in a limited-benefit For hospital services, plan. For collect hospital patient services, collect patient
responsibility when responsibility service is rendered when service or make is financial rendered arrangements or make financial with the arrangements patient in with the patient in
accordance with your accordance policies. with your policies.
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patient
Provider: Participant responsibility is enrolled in when a limited-benefit service is rendered plan. For or hospital make financial services, arrangements collect patient with the patient in
responsibility when service accordance is rendered with your or make policies. financial arrangements 15 AWAY with the FROM patient HOME in CARE AWAY FROM HOME CARE
accordance with your policies.
AWAY FROM HOME CARE
AWAY FROM HOME CARE
012412
012412
2012 Starbridge 2012 Starbridge - Beech Street - Beech Street
PPO Plans
A V I A N T N E T W O R K
A V I A N T N E T W O R K
Primary Network: Beech Street
Primary Network: Beech Street
Connecticut General Life Insurance Company
Connecticut General Life Insurance Company
Starbridge ® Beech Street
Doctor Visit $25
Coverage Effective Date: 00/00/0000Doctor Visit $25
Coverage Effective Date: 00/00/0000
Specialist
Specialist
$25
$25
ID: Use Primary Insured’s Social Security Number
ID: Use Primary Insured’s Social Security Number
Network Coinsurance:
Network Coinsurance:
In 80%/20%
Name: Name
In 80%/20%
Name: Name
Out Out 80%/20%
80%/20%
Group Name:
Group Number:
Group Name:
Group Number:
11
• No PCP selection required
• No referrals required
• In-network and out-of-network coverage
www.starbridge.com
www.starbridge.com
SM
3 SM
For Benefits, Claim Status, For Benefits, Eligibility Claim or Customer Status, Eligibility Service, or Call Customer Service, 1-8XX-XXX-XXXX Call 1-8XX-XXX-XXXX
7
5
4
You may be asked to present this card when you receive care. The card does not guarantee
You may be asked to present
coverage.
this
You
card
must
when
comply
you receive
with all
care.
terms
The
and
card
conditions
does not guarantee
of the plan. Willful misuse of this card is
coverage. You must comply
considered
with all
fraud.
terms and conditions of the plan. Willful misuse of this card is
considered fraud.
This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims will
This plan does not require pre-certification of coverage for inpatient or outpatient services. Claims will
be paid according to terms and conditions of the plan. In the case of an emergency, seek care
be paid according to terms and conditions of the plan. In the case of an emergency, seek care
immediately, then call your family physician for further assistance and direction regarding follow up care.
immediately, then call your family physician for further assistance and direction regarding follow up care.
13
Send Claims to:
Send Claims to:
Connecticut General Life Insurance Company, PO Box 55270, Phoenix, AZ 85078-5270 Payor 59225
Connecticut General Life Insurance Company, PO Box 55270, Phoenix, AZ 85078-5270 Payor 59225
Customer Service: Customer 1.800.XXX.XXXX
Service: 1.800.XXX.XXXX
CIGNA 24-hour CIGNA Nurseline: 24-hour 1.866.XXX.XXXX
Nurseline: 1.866.XXX.XXXX
14
Provider: Participant Provider: is enrolled Participant in a limited-benefit is enrolled plan. in a For limited-benefit hospital services, plan. For collect hospital patient services, collect patient
responsibility when service responsibility is rendered when or service make financial is rendered arrangements or make financial with the arrangements patient in with the patient in
accordance with your accordance policies. with your policies.
AWAY FROM HOME CARE AWAY FROM HOME CARE
2012 FundamentalCare 2012 FundamentalCare - CIGNA - HealthCare CIGNA HealthCare PPO PPO
2012 Starbridge 2012 Starbridge - CIGNA - HealthCare CIGNA HealthCare PPO PPO
012412
TPV / Alliance TPV / Alliance
TPV Logo / Alliance TPV / Logo Alliance 11
www.fundamentalcare.com www.fundamentalcare.com
Logo
Logo
Primary Network: CIGNA Primary HealthCare Network: PPOCIGNA HealthCare PPO
www.starbridge.com
www.starbridge.com
Secondary Primary Network: CIGNA Beech Primary HealthCare
Secondary Street Network: PPOCIGNA HealthCare PPO
Network: Beech Street 5
Connecticut Secondary Network: General Life Beech Secondary
Connecticut Insurance StreetNetwork: General Company Beech Street
Life Insurance Company
Connecticut General Life Connecticut Insurance General Company Life Insurance Company
Doctor Visit
Coverage Effective Date: Doctor $25 Visit $25
Coverage
00/00/0000
Effective Date: 00/00/0000 Doctor
Coverage Effective Date: 00/00/0000 Specialist Visit Doctor $25
Coverage Effective Date: 00/00/0000
Visit
Specialist $25
$25
$25
ID: AMI
Specialist 7
ID: AMI
Network Coinsurance: Specialist $25
4
$25
ID: AMI
Network Coinsurance:
ID: AMI
Network In Coinsurance: Network
Name: Name
In
80%/20% Coinsurance:
80%/20%
Name: Name Name: Name
In
Name: Name
Out In 80%/20%
SM Out
80%/20% 80%/20%
Out 80%/20%
Out
Account Number:
Account
2466518
SM 80%/20% 3 SM 80%/20%
Account Number: Number: 2466518
Account 2466518 Number: 2466518
Starbridge ® Cigna PPO
Group Name:
Group Group Number: Name:
Group Number:
012412
Group Name:
Group Name:
Group Number:
Group Number:
A V I A N T N E T W O R K
A V I A N T N E T W O R K
A V I A N T N E T W O R K
A V I A N T N E T W O R K
• No PCP selection required
• No referrals required
• In-network and out-of-network coverage
You may be asked to present You may this be card asked when to present you receive this card care. when The card you does receive not care. guarantee The card does not guarantee
coverage. You may be You asked must to comply present You
coverage.
may with this be
You all card asked terms must
when to and comply
present you conditions receive
with
this
all
card care. of terms the when The plan. and
card you
conditions Willful receive does misuse not care.
of
guarantee
the of The this plan.
card card Willful
does is not
misuse
guarantee
of this card is
considered coverage. You fraud. must comply coverage.
considered
with You all
fraud.
terms must comply and conditions with all of terms the and plan. conditions Willful misuse of the of plan. this card Willful is misuse of this card is
This considered plan does fraud. not require considered
This pre-certification plan does
fraud.
not require of coverage pre-certification for inpatient of coverage or outpatient for inpatient services. or Claims outpatient will services. Claims will
be This paid plan according does not to require terms This
be paid
plan pre-certification and according conditions does not
to
require of of
terms the coverage pre-certification plan. and conditions In for the inpatient case of
of coverage
the an or emergency, outpatient
plan. In
for
the
inpatient services. seek case of care or Claims
an
outpatient will
emergency,
services.
seek care
Claims will
immediately, be paid according then call to terms be your immediately,
paid family and according conditions physician then
to of
call
terms for the
your further and plan.
family
conditions assistance In the case
physician
of and of
for
the an direction further
plan. emergency, In
assistance regarding the case seek
and
of care follow an
direction
emergency, up care. regarding
seek care
follow up care.
immediately, then call immediately, your family physician then call for your further family assistance physician and for further direction assistance regarding and follow direction up care. regarding follow up care.
Send Claims to: TPV / Send Alliance Claims Mailing to: Address TPV Alliance Mailing Address
Send Claims to: TPV /
All others to: CIGNA HealthCare, Send Alliance Claims Mailing
All others
P.O. to:
to: CIGNA
Box TPV Address
188004, / Alliance
HealthCare,
Chattanooga, 13 Mailing Address
P.O. Box 188004,
TN 37422
Chattanooga,
Payor 62308
TN 37422 Payor 62308
All others to: CIGNA HealthCare, All others to: P.O. CIGNA Box 188004, HealthCare, Chattanooga, P.O. Box 188004, TN 37422 Chattanooga, Payor TN 62308 37422 Payor 62308
Customer Service: Customer 1.800.XXX.XXXX
Customer Service: Customer 1.800.XXX.XXXX
Service:
Service:
1.800.XXX.XXXX
1.800.XXX.XXXX 14
CIGNA 24-hour CIGNA Nurseline: 24-hour 1.866.XXX.XXXX
CIGNA 24-hour CIGNA Nurseline: 24-hour 1.866.XXX.XXXX
Nurseline:
Nurseline:
1.866.XXX.XXXX
1.866.XXX.XXXX
2012 Starbridge 2012 Starbridge - Beech - Street Beech Street
Provider: Participant is enrolled in a limited-benefit plan. For hospital services, collect patient
Provider: Participant is enrolled in limited-benefit plan. For hospital services, collect patient
responsibility Provider: Participant when service Provider: is enrolled is rendered Participant in a limited-benefit or make is enrolled financial plan. a arrangements limited-benefit For hospital services, with plan. the For patient collect hospital patient in services, collect patient
responsibility when service is rendered or make financial arrangements with the patient in
accordance responsibility with when your service responsibility policies. is rendered when or service make is financial rendered arrangements or make financial with the arrangements patient in with the patient in
accordance with your accordance with your policies.
accordance policies. with your policies.
15
AWAY FROM HOME CARE
AWAY FROM HOME CARE AWAY FROM HOME CARE
AWAY FROM HOME CARE
65
A V I A N T N E T W O R K
A V I A N T N E T W O R K
Primary Network: Beech Street
Connecticut General Life Primary Insurance Network: Company Beech Street
Connecticut General Life Insurance Company
www.starbridge.com
www.starbridge.com
You may be asked to present this card when you receive care. The card does not guarantee
coverage. You must comply
You may
with
be
all
asked
terms
to
and
present
conditions
this card
of
when
the plan.
you
Willful
receive
misuse
care. The
of this
card
card
does
is
not guarantee
considered fraud.
coverage. You must comply with all terms and conditions of the plan. Willful misuse of this card is
This plan does not require
considered
pre-certification
fraud.
of coverage for inpatient or outpatient services. Claims will
be paid according to terms This plan and does conditions not require of the pre-certification plan. In the case of of coverage an emergency, for inpatient seek care or outpatient services. Claims will
immediately, then call be your paid family according physician to terms for further and conditions assistance of and the direction plan. In the regarding case of follow an emergency, up care. seek care
immediately, then call your family physician for further assistance and direction regarding follow up care.

PPO or EPO Plans
TPV logo
11
CSN logo
Cigna
Care Network
Legal entity name
Coverage effective date: MM/DD/CCYY
Group: 1234567
Issuer (80840)
ID: U23456789 01 1
Name: John Public
5
10
18
6
ID card acct name
RxBIN 600428 RxPCN 02150000
NSP
DOI
logo
9
Network Savings Program
• No PCP selection required
• No referrals required
• PPO: In-network and out-of-network coverage
• EPO: In-network coverage only, except emergency care
7
Client
logo
PPO
Dr. visit $10/$25
Specialist $10/$25
Hospital ER $50
4
Urgent care $25
Vision
Yes
Rx $10/20/30
Network coinsurance:
In 90%/10%
3
Out 70%/30%
Med/Rx deductible applies
Cat#
12
WWW.CIGNA.COM
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION AND OUTPATIENT PROCEDURES:
Your network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents
for your pre-certification requirements. Failure to do so may affect benefits. In an emergency, seek care immediately, then call your
primary care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.
For pharmacy, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
For vision, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
Send claims to:
CAD name, PO Box XXXX, Anytown, USA 12345-6789 13
TPV name, PO Box XXXX, Anytown, USA 12345-6789
All others: PO Box XXXX, Anytown, USA 12345-6789
Customer service: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXX
14 15
AWAY FROM HOME CARE
Strategic Alliances
TPV / Alliance
logo
11
5
Legal entity name
Coverage effective date: MM/DD/CCYY
Group: 1234567
7
Issuer (80840)
ID: U23456789 01 1
Name: John Public
PCP: John Smith
PCP name Ln2
PCP phone: 860.555.1212
ID card acct name 10
NSP
RxBIN 600428 RxPCN 02150000 logo
DOI
Network Savings Program
• PCP selection encouraged
Client
logo
Open Access Plus
No referral required
PCP visit $15
Specialist 4 $30
Hospital ER $50
Urgent care $25
Vision
Yes
Rx $10/$20/$40/90%
Rx indiv deduct $50
Network coinsurance:
In 90%/10%
9 3
Cat#
12
13
WWW.CIGNA.COM
You may be asked to present this card when you receive care. The card does not guarantee coverage.
You must comply with all terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION:
Your network provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents
for your pre-certification requirements. Failure to do so may affect benefits. In an emergency, seek care immediately, then call your
primary care doctor as soon as possible for further assistance and directions on follow-up care within 48 hours.
Coinsurance/deductible is paid directly to the doctor/facility by Cigna using individual’s available health funds.
For pharmacy: Call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
For vision: Call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
Send claims to: CSN name, PO Box XXXXX, Anytown, USA 12345-6789
All other: PO Box XXXXX, Anytown, USA 12345-6789
Customer service: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXX
14
We encourage you to use a PCP as a valuable resource and personal health advocate.
15
AWAY FROM HOME CARE
Indemnity Plans
5
5
Legal entity name
Coverage effective date: MM/DD/CCYY
Group: 1234567
Issuer (80840)
1
1
ID: U23456789 01
Name: John Public
10
ID card acct name
RxBIN 600428 RxPCN bk 02150000 NSP
DOI
logo 9
Network Savings Program
• No PCP selection required
• No referrals required
• Patient files claims
7
Client
logo
Indemnity
Rx $10/20%/40%/100%
Rx indiv deduct $50
Indiv deduct $300
Family deduct $500
Hospital deduct $200
ER deduct $50
Coinsurance:
Medical 80%/20%
Med/Rx deductible applies
Cat#
3
12
13
WWW.CIGNA.COM
You may be asked to present this card when you receive care. The card does not guarantee coverage. You must comply with all
terms and conditions of the plan. Willful misuse of this card is considered fraud.
INPATIENT ADMISSION:
Your provider must call the toll-free number listed below to pre-certify the above services. Refer to your plan documents for your
pre-certification requirements. Failure to do so may affect benefits. In an emergency, seek care immediately, then call your primary
care doctor as soon as possible for further assistance and directions on follow-up care within ### hours.
Coinsurance/deductible is paid directly to the doctor/facility by Cigna using individual’s available health funds.
Note: You can reduce your out-of-pocket expenses if you use a Network Savings Program provider. Use of a Network Savings
Program provider does not affect your benefit coverage. For help finding a participating provider, please visit our website, or call
the toll-free number listed on this card.
For Pharmacy, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
For Vision, call ABC Company 1.800.XXX.XXXX (Not a Cigna Company)
Send Claims to: PO Box XXXX, Anytown, USA 12345-6789
Customer Service: 1.800.XXX.XXXX MH/SA: 1.800.XXX.XXXX
14
67

MORE WAYS TO ACCESS PATIENT
INFORMATION WHEN YOU NEED IT
USE OUR ELECTRONIC TOOLS
• Log in to the Cigna for Health Care Professionals website (CignaforHCP.com)
• Connect to us through electronic data interchange (EDI): visit Cigna.com > Health Care Professionals >
Resources > Doing Business with Cigna > How to Submit Claims to Cigna to learn more
• Call our automated phone system 1.800.88Cigna (882.4462)
CONDUCT ADMINISTRATIVE TRANSACTIONS ONLINE
Cigna’s convenient eServices tools help you manage the administrative details of health care.
• Access patient eligibility and benefits
• Estimate patient liability
• View and submit precertification requests
• Check claim status
• Enroll online for electronic funds transfer (EFT), then view, print, and share online remittance reports the
same day you receive electronic payments
• Receive electronic remittance advice and automatically load it to your accounts receivable system
• Submit questions about fee schedules and specific patient benefits
learn more
To access our educational resources, log in to CignaforHCP.com > Resources > Medical eCourses for courses
about EDI, electronic claim submission, claim status inquiry, appeals, and more.
“Cigna,” the “Tree of Life” logo and “GO YOU” are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and
its operating subsidiaries. All products and services are provided by such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries
include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service
company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. All models are used for illustrative purposes only.
i
591795 p THN-2013-195 11/13 © 2013 Cigna. Some content provided under license.